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Biomedical subjects

M Keckeisen

Publications and source records attributed to M Keckeisen.

4 recordsLinked to original sources
PubMed1996

Improving pain management in critical care.

BACKGROUND: In April 1994 at the University of California at Los Angeles Medical Center the Surgical Intensive Care Unit's (SICU's) Quality Improvement Council unanimously agreed on pain management as one of the major factors that negatively affect outcomes for their patient population. Using the FOCUS-PDCA (plan-do-check-act) model for quality improvement (QI), the council chartered a subcommittee to improve the pain management in their ICUs. METHODOLOGY: The subcommittee first measured the pain assessment scores of patients at transfer from the ICU. After ascertaining that these scores were greater than the goal of 2, the process of providing pain relief was examined with the assistance of process control statistics, which showed a process barely capable of meeting the goal of pain score of 2 or less on a 0-5 scale. The process factors that affected this outcome were examined and changes were made where appropriate. One of these changes was development of a guideline for acute pain management based on the Agency for Health Care Policy Research's Acute Pain Management Clinical Practice Guideline. Reassessment of the pain scores and the process was then conducted. RESULTS: The pain assessment scores at transfer from the ICU decreased significantly. Thirty-five percent of patients in the preguideline survey rated their scores as greater than 2, compared with only 21% at the postguideline survey. Pain assessment and documentation also improved significantly. CONCLUSION: The Quality Improvement Council felt that improvements in pain management were due largely to their having provided staff with the right tools to use in assessing, documenting, and controlling pain. Gains in pain management continue to be made.

Hospitals, University↗
PubMed1991

Techniques for measuring arterial pressure in the postoperative cardiac surgery patient.

Blood pressure measurement and management of the cardiac surgical patient do not appear to be simple processes. The critical care nurse needs to understand thoroughly the many technical and physiologic variables pertaining to the equipment used (i.e., cuff size, stethoscope placement, automated device cycling patterns, and monitoring system accuracy and reliability); the patient (i.e., cardiac output, PVR, hypothermia, and placement site and length of the intra-arterial catheter); and the relationship of indirect to direct measurement. The choice of therapy, i.e., volume or drug therapy (vasodilator or vasopressor), should be based on a thorough understanding of the technical and physiologic factors influencing the readings and their relationship to indirect and direct measurement of the blood pressure. Once the nurse understands the correlation of the indirect and direct blood pressure readings, choosing the pressure reading that one "likes" will no longer be an issue.

Blood Pressure Monitors↗